• 대한통합의학회지
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• 제10권2호
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• pp.105-113
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• 2022

Purpose: The purpose of this study is to investigate the effect of non-invasive transcranial direct current stimulation (tDCS) on muscle activity, including 10 m WT, TUG, and BBS, in hemiplegic stroke patients. Methods: This study was conducted on 42 inpatients diagnosed with hemiplegia due to stroke at hospital B in Daejeon for more than 6 months. Walking training was conducted for six weeks, five times a week for 30 minutes, with a general walking group (14 people), tDCS walking group (14 people), and tDCS (sham) walking group (14 people). Results: As a result of the study, the change in the muscle activity before and after tDCS intervention was significantly increased in the tibialis anterior muscle in the CG group. In the EG group, the erector spine (lumbar), rectus femoris, and tibialis anterior muscles significantly increased. In the SEG group, significant increases were observed in the rectus femoris and tibialis anterior muscles. Significant differences were found in the rectus femoris and tibialis anterior muscles in the comparison between groups after intervention according to tDCS application. Also, 10 m WT, TUG, and BBS were significantly increased in the CG, EG, and SEG groups after intervention, and there were significant differences in 10 m WT, TUG, and BBS in comparison between groups after intervention according to tDCS application. Conclusion: As a result, tDCS is an effective in improving the walking ability of stroke patients, and in particular, it effectively increases the muscle activity of the rectus femoris and tibialis anterior muscles, which act directly on walking, and also improves the speed and stability of walking. It is considered being an effective method to increase the gait of stroke patients by combining it with the existing gait training.

• 대한통합의학회지
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• 제1권4호
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• pp.9-14
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• 2013

Purpose : The purpose of this study was to investigate the effect of visual Auditory rhythmic stimulation(VARS) in gait ability and proprioception with chronic stroke patients. Twenty-one persons after six months post stroke participated in pre test-post test control. Method : The subjects were randomly assigned to a visual Auditory rhythmic stimulation(VARS) group (n=10) and control group (n=11). Training process was practiced with exercise on thirty minutes a day, three days a week for four weeks. To find out the effect, inspected the FRT(functional reach test) by static balance and TUG(timed up and go test) by dynamic balance. Results : In static balance, FRT distance was significantly different between two group. In dynamic balance, TUG time was significantly different between two group. This study showed that the VARS training increase a balance by postural adjustment of chronic stroke patients more than control group. And so, the VARS training of hemiplegic patients was very important to successive rehabilitation. Conclusion : A continuous examination of VARS training could practical used of physical therapy with exercise.

• 대한정형도수물리치료학회지
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• 제25권1호
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• pp.21-27
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• 2019

Background: The purpose of this study was to investigate the effects of Graston technique for lower extremity range of motion (ROM), muscle strength, walking ability in hemiplegia patients. Methods: Twelve subjects participated in this study. The ROM of the knee extension was measured by 90-90 straight leg raise test, the hamstring and quadriceps muscle strength was collected by utilizing a handheld dynamometer. In addition walking speed was evaluated by 10 meter walking test. The group was applied intervention using a Graston instrument for one minute. After intervention, immediate effect was assessed. The significant level was set at ${\alpha}=.05$. Results: The ROM of the knee extension, quadriceps muscle strength and walking speed were significantly increased. Hamstring muscle strength was significantly reduced. Conclusion: The results of this study suggest that Graston instrument technique has the effect of instantaneously flexibility the muscles, and the muscle applied with the technique has weakened, while the muscle of the opposite side has increased the muscle strength. In addition, the muscle flexibility and the walking speed have increased.

• 한국운동역학회지
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• 제29권1호
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• pp.15-21
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• 2019

Objective: The purpose of this study was to investigate the effects of aqua-noodles on the practice of underwater walking in patients with hemiplegia. Method: After an oral explanation and signing an IRB approved consent form 10 participants ($66.8{\pm}10.75yr$, $165.3{\pm}8.79cm$, $73.6{\pm}46kg$) agreed to participate in this study. Each of the participants was required to walk with the aqua noodles and without the aqua-noodles in a swimming pool. Each participant was asked to walk a distance of 5 m a total of 10 times, 5 with and 5 without the aqua-noodles. The depth of the swimming pool was at 1.3 m, approximately chest height. The following variables were calculated for analysis; height of the knee (m), knee joint ROM ($^{\circ}$), ankle joint ROM ($^{\circ}$), knee joint maximum angular velocity ($^{\circ}/sec$), and ankle joint maximum angular velocity ($^{\circ}/sec$). Results: First, there was a significant increase in time (s) for the maximum knee height to reach as well as the maximum knee height (m) increased when the participant used the aqua-noodles. Second, there was a statistically significant decrease in stride length when the aqua-noodles were used. Conclusion: This study helps to verify that the effect of underwater walking exercise can provide a suitable walking exercise environment. The results of this study provide systematic scientific information about how walking in water can be used for the rehabilitation of patients and the elderly.

• 대한의용생체공학회:의공학회지
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• 제20권2호
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• pp.183-190
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• 1999

본 논문은 족하수 환자를 대강으로 휴대가 간편하고 사용이 편리한 피드백 제어형 전기자극기를 제안하는 데 그 목적이 있다. 이 시스템은 교통사고, 산업재해, 뇌졸중 등으로 인하여 하지마비를 동반한 환자에서 마비된 하지근의 위축 및 괴사를 방지하고 혈액순환을 증가시킬 뿐만아니라 보행을 보조하여 안정된 활동을 가능케 한다 피드백 제어형 전기자극기는 환자가 오랜 시간 보행시 전극의 임피던스 변화나 근피로에 의해 족하수증이 다시 발생하게 되면 관절각의 변화가 관절각 센서에 의해 검출되고 이때의 오차는 PID 제어에 의한 자극전압의 변화를 가져와 설정된 위치에 발목이 도달하도륵 자극레벨이 자동 조절된다. 자극조건은 자극주파수 40 Hz, 자극펄스 0.2 ms, 30∼80 V이다. 족하수 환자 5명을 대상으로 42일 동안 첫째 1주일 동안에는 하루에 15분을 자극하고, 다음 주기는 1주일 단위로 하루에 30분, 60분, 70분, 120분씩 점차적으로 시간을 증가하면서 자극하였다. 이때 근력은 27.7%가 향상되었고, 근 피로도는 22.9%가 감소되었다. 이런 결과를 종합할 때 피드백 제어형 전기자극기는 족하수 환자의 보행기능 및 운동기능을 회복하는 데 효과적이라 하겠다.

• 대한정형도수물리치료학회지
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• 제11권1호
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• pp.11-28
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• 2005

Spasticity has been defined as "a motor disorder characterized by a velocity-dependent increased in tonic stretch reflexes with exaggerated tendon jerks, resulting from hyperexcitability of the stretch reflex, as one components of the upper motorneuron syndrome". Spasticity is one of the common symptoms of stroke patients and frequently interferes with the motor functions such as gait, posture and activities of daily living. Therefore, its management is becoming a major issue in physical therapy. The purpose of this study was to determined the effects of reciprocal inhibition by isometric contraction of pre-tibia muscle on spasticity in hemiplegic patients through Hoffmann reflex. The subjects were consisted 45 patients who had hemiplegia due to stroke. All subjects randomly assigned to 3 group: manual reciprocal inhibition program group(manual group), neuromuscular electrical stimulation group(NMES group) and control group. The manual group received voluntary isometric contraction of pre-tibia muscle. The NMES group received neuromuscular electrical stimulation on tibialis anterior. The control group was not received any therapeutic intervention. Before and after experiments, Hoffmann reflex, M-wave and Modified Ashworth scale was measure in all patients. The data of 30 patients who complete experimental course were statistically analysed. Modified Ashworth scale were significantly decreased after experiment in manual group(p<.01). The Hmax/Mmax ratios were significantly decreased after experiment in manual group(p<.o1). There were no statistical difference between pre-test and post-test with modified Ashworth scale in NMES group(p>.01). There were no statistical difference between pre-test and post-test with Hmax/Mmax ratios in NMES group(p>.01). There were no statistical difference between pre-test and post-test with modified Ashworth scale in control group(p>.01). There were no statistical difference between pre-test and post-test with Hmax/Mmax ratios in control group(p>.01). The present results revealed that reciprocal inhibition which produced by voluntary isometric contraction of pre-tibia muscle can be reduce spasticity of gastrocnemius. Therefore, reciprocal inhibition is useful to improve functional activities in hemiplegic patient. Further study should be done to analyse the effects of intervention duration of reciprocal inhibition, appropriate muscle contraction, optimal time to apply the reciprocal inhibition in more long period.

• 대한물리의학회지
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• 제12권3호
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• pp.99-104
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• 2017

PURPOSE: Gait disturbances in patients with hemiplegic stroke involve asymmetry of stance time. Step box training is used to supplement the limitations of stair walking training and increasing the torque value of the paralyzed lower leg's strength. This study aimed to investigate whether step-up training on unstable support could change walking ability in patients with chronic stroke. METHODS: Thirty stroke patients were randomly assigned to the step-up training group (experimental group), that performed training on an unstable surface, and the control group, that performed training on a stable surface. Walking speed, step length, and cadence were measured before and after training. Paired t-tests were used to compare pre- and post-intervention data, while the independent samples t-test was used to determine intergroup differences. Values of p < .05 were considered statistically significant. RESULTS: There was a significant difference in walking ability before versus after the intervention in both groups, although the experimental group showed greater differences than the control group (walking velocity by 8.1%; step length of the non-paralyzed side by 6.9%, respectively; p<.05). CONCLUSION: Step-up training might be more effective on an unstable surface than on a stable surface for increasing walking speed and step length of the non-paralyzed side.